111 S BROOKHURST STCity of Anaheim
BUILDING DIVISION
INSPECTION RECORD
SIGN PERNUT
ADDRESS: 111 S BROOKHURST ST
OWNER: KEY CENTRE DEVELOPMENT
PERMIT #: SGN2021-00088
DATE ISSUED: 7/29/2021
DESCRIPTION: Install (2) illuminated wall signs for "All Smiles Family & Children
Dentistry'.
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE
ON THE JOB SITE
Inspection
Code
Date
Inspector
SET BACK, FORMS,
TRENCHES
602
UNDERGROUND
CONDUIT
604
MASONRY:
REINFORCEMENT,
BOND BEAM,
606
PRE -GROUT
FINAL699
MISCELLANEOUS INSPECTIONS
Inspectors can normally be reached between
7:30 - 8:00 A.M. and 3:30 - 4:30 P.M.
(714) 765-5153 + 0
signcard
INSPECTION REQUIREMENTS
Contractor shall verify with the City Inspector prior
to final inspection if a representative is required to
be on the site to expose any concealed wiring for
final inspection.
INSPECTION REQUESTS
Inspection requests made before 5:00 pm will
be scheduled on the following workday.
To schedule your building inspection online,
please go to
hftp://www.anaheim.net/inspectionRequest.
You may also request your inspection by calling
(714) 765-4626 and continue with the following
steps:
• Press 1 for inspection function.
• Press 1 to schedule inspection.
• Press 6 for Sign inspection.
• Enter your permit # 202100088.
• Enter the Code number for the inspection
requested (indicated in blue.)
• Press 1 for next business day, or enter date
ti
preferred.
• Select time preference (Request is subject to
inspector's schedule.)
• At the end of your request you will receive a
confirmation number.
To access your inspection timeframe, please go to
www.anaheim.net/building after 7:30 am on the day of your
inspection. Under Online Services, click on the
"Inspection Timeframes" link or call (714) 765-5153 + 0.
SIGN PERMIT NO. SGN2021-00088 r_' 1, - BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
TYPE OF PERMITINSPECTION REQUEST LINE:
New Attached to Structure Sign CITY OF A4.NAHEIM (714) 765 - 4626
DATE: 7/29/2021 _ QUARTER SECTION: 33
JOB ADDRESS: 111 S BROOKHURST ST
LEGAL DESCRIPTION: SEC 18 T 4 R 10 N 216 FT E 180 FT E
PERMIT APPLICANT: MIKE HEFFERNAN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
KEY CENTRE DEVELOPMENT SUNSET SIGNS AND PRINTING INC
P 0 BOX 488 2906 E CORONADO ST
TIBURON, CA 94920-0488 ANAHEIM, 92806 0000 CA
JOB DESCRIPTION: Install (2) illuminated wall signs for "All Smiles Family & Children Dentistry".
VALUATION: 4,000.00 PROCESSED BY: EGA
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of pedury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5 Business and Professions Code: any city or
county which requires a permit to construct, after, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed
statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professions
Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044 Business
and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or
through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold with one year of
completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale).
❑ I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law).
❑ 1 am exempt under Sec. B & P.C. for this reason:
Date: Owner:
WORKER'S COMPENSATION DECLARATION LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: I hereby affirm under penalty of perjury that I am licensed
❑ 1 have and will maintain a certificate of consent to self -insure for workers compensation, as provided for under provisions of chapter 9 (commencing with Section 7000)
by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. of Division 3 of the Business and Professions Code.
fI have and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code,
the performance of the work for which this permit is issued. My workers Compensation insurance carrier
and policy are:
Carrier. SECURITY NATIONAL INS. CO. Policy Number. SWC1275696
This section need not be completed if t he permit is for one hundred dollars ($100) or less.
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in
any manner so as to become subject to the workers compensation laws of Califomia, and agree that if I should
become subject to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 7/29/2021 Applica?RKERS
WARNING: FAILURE TO SECURE COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATIoN, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY 1
I hereby affirm under penalty of pedury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec.3097.Civ.C):
Lenders Information:
I certify that I have read this application and state that the above information is correct. I agree to comply with
all city ordinances and state laws relating to building construction, and hereby authorize representives of this
city to enter upon the above mentioned property for inspection purposes.
. d' . I i
v I-V v ` Date: 7/29/2021
Signature of Applicant or Agent
The pe it shall expire by limitation and become null and void if the building or work has
not passed final inspectoin 365 days from the date of permit issunace. A new permit is
required to commence or continue work.
Date: 7/29/2021 Contractor:
NUMBER: EXPIRATION DATE:
BUS2021-01445 5131/2022
TYPE: C45
TYPE: BUS
Quanity: 2
Electric Sign (Y/N): Y
Fees paid orPermit:
Total:
677.75